Year 2010 temporary budget to make available the ... - Jersey City

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-.~~ ._---_--_._~.-.~-,~_.~~_.~---~~~._--..-._.~ -_'.-~-----_'_----~~'-----_"~._-~,--.-.-.-_.~.~-,..,.,-'--'~'-"'-~"-"--~--~~"-~-------~._--~-----.~--.~ CERTIFICATION OF COMPLIACE WITH THE CITY OF JERSEY CITY CONTRACTOR PAY.To-PLAY REFORM ORDINANCE 08-128 ADOPTED ON SEPTMBER 3,2008 PART 1- Vendor Affiation' The undersigned, being authonzed and knowledgeable of the circumstaces, does hereby certify that Flagship Health Systems, Inc. (name of business entity) has not made any reportble contrbutions in the **one-year perod preceding 1/1/09 . (date City Council awards contract) that would be deemed to be violations of Section One of the City of Jersey City's Contractor Pay-to-Play Reform Ordinance 08-128 ( attched hereto) and that would bar the award of ths contract. I fuer certify that durg the term of the contract Flagsfiip Health Systems, Inc. (name of 128. business entity) will not make any reportble contrbutions in violation of Ordiance 08- PART II - Signtue and Attstation: The undersigned is fully aware that if! have misrepresented in whole or par thsaffmnation and certifcation, I and/or the busess entity, wil be liable for any penaty permtted under law. Name of Business Entity: Signed Title: Sr. Vice President & General CmIDsel Pnnt Name Douglas Sanborn Date: 12/10/09 Subscriked and sworn before me this ~day oftÆ., 2.J. My Coirssion expires: Counsel KA'I( LO NOAR Pl Of lE JERS MY CO Ex'. 2. 2012 (pnnt Damc & titlc of affiant) (Corporatc Seal) **Puuat to Section 2 of Ordiance 08-128, no contnbutions or solicitation of contrbutions made pnor to the effective date Ordinance 08-128 (September 23,2008) shall be deemed to be a violation of the Ordinance.
Reqúisition # 0148636 Vendor DELTA DENTAL OF NEW JERSEY 1639 ROUTE 10 PARSIPPANY NJ 07054. DE149514 CITY OF JERSEY CITY Requisition Dept Bil To HEALTH BENEFITS CITY HALL 280 GROVE ST. ROOM 107 JERSEY CITY NJ 07302 Contact Info MICHALINE YURCIK 0000005515 Quantity UOM Description Account 1.00 1 CLOSED DENTAL PLAN 01-201-23-220-803 CLOSED DENTAL PLAN FOR ALL EMPLOYEES AND THEIR ELIGIBLE DEPENDENTS CONTRACT PERIOD: JANUARY 1, 2010 TO DECEMBER 31,2010 TOTAL CONTRACT AMOUNT: $688,000.00 AMOUNT TO BE ENCUMBERED: $172,000.00 Req. Date: 12/08/2009 Requested By: MICHALNE Buyer Id: Approved By: This Is Not A Purchase Order ¡ Assigned PO # Oept Ship To CITY HALL 280 GROVE ST. ROOM 107 JERSEY CITY NJ 07302 Unit Price .00 Requisition Total Total .00 .00 J
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City Clerk File No. Agenda No. Appr
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Continuation of Resolution City Cle
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()- 00;1 EXHIBIT A JAN i 3 2010 BLO
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Block: 00763 Principal: 3,167.01 Ta
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N N N ~ -c N m 0 0 0 0 ;i 0 0 0 0 ;
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Memo to Brian O'Reiley, Business Ad
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Resolution of the City of Jersey Ci
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LEGISLATIVE FACT SHEET This summary
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of the Licensee or anyone employed
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14. Failure to adhere to the terms
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HOST CITY AGREEMENT THIS HOST CITY
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Page 43 and 44: Aricle 36 November 16,2009 Add new
Page 45 and 46: wil be $50 per 30-day supply, meani
Page 47 and 48: Continuation of Resolution City Cle
Page 49 and 50: CERTIFICATION OF BRIAN O'REILLY IN
Page 51 and 52: . AFTI ACTION COMPLIACE NOTICE N.J.
Page 53 and 54: EXITA N.J.s.A. 10:5-31 aDd N.J.AC.
Page 55 and 56: APPENIX A AMRICANS WI DISABIL ACT O
Page 57 and 58: " Taxpayer Identifcation# 221~896.1
Page 59 and 60: 0148637 CITY OF JERSEY CITY Requisi
Page 61 and 62: A summary of Aetna's proposal rates
Page 63 and 64: City of Jersey City Dental Program
Page 65 and 66: UL-\, .L C- C-UiiO .L-i- Jc: veL I
Page 69 and 70: CERTIFICATION OF BRIAN O'REILLY IN
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Page 73 and 74: EXIT A N.J.s.A. 10:5-31 and N.J.AC.
Page 75 and 76: APPENDIX A AMRICANS WI DISABIL ACT
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Page 81 and 82: . A sumary of Aetna's proposal rate
Page 83 and 84: Total Annual: Total Monthly: $158,0
Page 85 and 86: VcL-l¿-¿~~~ IJ;J¿ DEL TA DENTAL
Page 89 and 90: EXTRAORDINARY UNSPECIFIABLE SERVICE
Page 92: Requisition # 0148639 Vendor RELIAS
Page 95 and 96: EXIT A N.J.s.A.IG:5-3la.d N.J.A.C.
Page 97 and 98: APPENIX A AMRICANS WI DISABIL ACT O
Page 99 and 100: ./ Resolution of the City of Jersey
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Page 103 and 104: FULL TITLE OF RESOLUTION: RESOLUTIO
Page 105 and 106: 61/64/2636 12: 62 9735860221 JAALE.
Page 107 and 108: 01/04/2030 12: 02 9736800221 JAALEX
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":.'~" (l-~.. DEPAATUE1' OF 1'REASY
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EXHIT A 'MAATORY.EQUAL EMPLOYM OPPO
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C6r~ôn CERTIFICATE OF EMPLOYEE INF
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MioritylWoman BuSÎJess Enterprise
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.: i ..; ..' . TAXPAYER NAME: CHUKS
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AGREEMENT AGREEMENT made this _ day
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ARTICLE iv Compensation and Payment
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loss of life or property or in any
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executed by their duly authorized o
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EXBmIT A (Cant.) The contractor or
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Questionnaire for Bidders Jersey Ci
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" Treasurer ~: State Certification
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,"" -' CERTIFICATION IN SUPPORT OF
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Consulting Services Agreement For t
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A. The selected consultant shall pu
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The parties hereto reserve the righ
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A business organization that fails
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! . ¡', '" I.: " l~ . CERnFCATION
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This Agreei:ent dated the AGREEMENT
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approved in advance for any specifi
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et seq. 2. An Affirmative Action Em
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City Clerk File No. Pg. #-- Agenda
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. ; ii/12/20El9 10: ld 2131-547-523
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JRN-07-211111 15:34 trDm:2016536979
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month an affidavit of services spec
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The City does not agree to pay for
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administration of this contract. Al
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such as court reporters, investigat
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The City does not agree to pay for
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AGREEMENT . Ths Agreement dated the
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Should the services of one or more
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affixed the day, month and year abo
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Continuation of Resolution Pg. # 2
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cents ($1.50) per page; and (ii) ch
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pursuant to section 1 ofP.L.2001, c
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the preceding month. All statements
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complete or substantially complete
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Robert Byrne City Clerk Brian O'Rei
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Continuation of Resolution Pg. # Ci
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Requisition # 0148621 Vendor SOLOMO
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City of Jersey City Department of H
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VII. RECORDS AND FILES' All patient
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EXHIBIT A (Cont.) The contractor or
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MINORITY/wOMAN BUSINESS ENTERPRISE
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-d!.~tlN~Ni~y "i"" State' Of New Je
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Princeton Insurance Company COMMON
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. BUSINESS ENTITY DISCLOSUR CERTIFI
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Requisition # 0148192 . Vendor EDUC
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EEO/ AFFIRMATIVE ACTION REQUIREMENT
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MINORITYIWOMAN BUSINESS ENTERPRISE
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P.L. 2004, c. 57 (N.J.S.A. 52:32-44
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, .' C. 271 POLITICAL CONTRIBUTION
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C. 271 POUTICAL CONTRIBUTION DISCLO
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List of Agencies with Elected Offic
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BUSINESS ENTITY DISCLOSURE CERTIFIC
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AGREEMENT THIS AGREEMENT entered in
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6. Purchases C) The City may send a
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12. Retention of Records Financial
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17. Labor Standards All laborers an
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Requisition # 0148794 Vendor HORIZO
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EEOIAFFIRMATIVE ACTION --REQUIREMEN
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State Treasurer HORIZON HEALTH CENT
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l'l.J. LlCIJWLllCHl VI llCè1:Sury
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C. 271 POLITICAL CONTRIBUTION DISCL
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Page_of Vendor Name: Continuation P
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CERTIFICATION OF COMPLIANCE WITH TH
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3. Compliance with Approved Program
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B) Subgrantees that receive at leas
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comply with such additional conditi
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20. Political Activity Prohibited N
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DETERMNATION OF VALUE CERTIFICATION
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EXHIBIT A MANDATORY EQUAL EMPLOYMEN
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APPENDIX A AMERICANS WITH DISABILIT
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Page L ot3 Public Contracts Equal E
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P.L. 2004, c. 57 (N.J.S.A. 52:32~44
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N.J. uepartent of Treasury - Uivisi
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Page_of Vendor Name: o Check here i
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DETERMINATION OF V ALUECERTIFICATIO
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EXHIBIT A MANDATORY EQUAL EMPLOYMEN
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APPENDIX A AMERICANS WITH DISABILIT
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P.L. 2004, c. 57 (N.J.S.A. 52:32-44
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C.271 POLITICAL CONTRIBUTION DISCLO
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. ~ , BUSINESS ENTITY DISCLOSURE CE
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AGREEMENT TIDS AGREEMENT entered in
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6. Purchses C) The City may send a
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ATTACHEMENT A PROGRAM DESCRIPTION:
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AGREEMENT . THIS AGREEMENT entered
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6. Purchses C) The City may send a
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ATTACHEMENT A PROGRAM DESCRIPTION:
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~. Requisition # 0148802 Vendor PHI
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EEO/ AFFIRMATIVE _.._----_._."---.
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Certification 778 CERTIFICATE OF EM
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MINORITYIWOMAN.BUSINESS ENTERPRISE
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l'l.J. UCPi:UIlCUl UL HCa:sury - Ui
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AGREEMENT THIS AGREEMENT entered in
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C) The City may send a representati
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Requisition # 0148804 Vendor . . PR
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EEO/ AFFIRMATIVE - --- - ----~- ---
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n.J. Ui;paiulll;llt vi ill;~UlY - u
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Page ::of 2- Vendor Name: Continuat
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City Clerk File No. Pg.#~ Agenda No
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Date Submitted ORDINANCEIRSOLUTION
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'~""- " JON S. CORZINE Governor Dec
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WILLIAMR. GOBLE, P.E., CITY ENGINEE
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Grant Application for State Aid to
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Grant Application for State Aid to
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Scope of Work cant' d Grant Applica
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CITY OF JERSEY CITY o E PA R TM E N
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Engineer's Estimate (12.03-2009) IT
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Project Classification (J Pedestria
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Name of Grantee: Jersey City Organi
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;:t:dn udlldynt:.. - Un:in¡; "'t:~
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LEGISLATIVE FACT SHEET This summary
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10. Any equipment installed or used
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Cit Clerk File No. Agenda No. 10.Z.
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and fully cooperate with the Direct
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7. Plan for collection ofuutstandin
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Dated: ~ SHEET 1 Dated: Director of
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Sheet 2 RECORDED VOTE- Ayes: SO-rOL
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SHEET3A ,. SEE BUDGET APPROPRIATION
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SHEET3B_1 PRIORYEAR.'S LOCAL MUNICI
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SHEET3C Totals days 265,942 $73,979
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09-206 34,736,189 ________-:_____._
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01/12/10 SHEET 18A I I I 13,711 I T
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I 01/12/10 SHEET 240 I I I I , ----
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TÖTALCAPITAL IMPROVEMENTS FROM "CA
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(Tis appendix must be Included in a
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Sheet 40b C-3 TOT ALS- ALL PROJECTS
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TOTALS. ALL PROJECTS 33-399 210,155
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Sheet 44 JAN 1 3 2010 Date If you h
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